Emergency Medicine

One in five patients with asthma receives unnecessary antibiotics at emergency department visits

Patients with asthma sometimes end up in emergency departments (EDs), gasping for breath due to inflamed and constricted airways caused by an asthma episode. They typically receive adrenalin and inhaled bronchodilators to open up their airways. However, a new study finds that some ED clinicians continue to prescribe antibiotics (perhaps because underlying lung infections spark asthma episodes), even though they have not been proven effective for asthma.

To determine the number of antibiotic prescriptions given to treat asthma in EDs, Massachusetts General Hospital researchers used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Emergency Department Safety Study (NEDSS). The NHAMCS data revealed that 22 percent of 16.1 million ED visits for asthma from 1993 to 2004 resulted in prescriptions for antibiotics. This number showed a slight decline to 20 percent in 2004, which could be attributed to the Centers for Disease and Control and Prevention's Get Smart campaign, intended to reduce inappropriate antibiotic use. Similarly, the NEDSS data from 2003 through 2006 showed that 18 percent of 4,053 patients with asthma seen in EDs received antibiotics.

Patients with asthma who received prescriptions for antibiotics tended to be older and live in the South and nonurban areas, which may benefit from targeted interventions for reducing antibiotic overuse. More whites than Hispanics and blacks received prescriptions for antibiotics, putting the minority patients at less risk for adverse reactions. Forty-four percent of the antibiotics prescribed for asthma patients fell into a class called erythromycin-lincosamides-macrolides, which have not been shown to be useful for treating asthma. This study was funded in part by the Agency for Healthcare Research and Quality (HS13099).

See "Inappropriate use of antibiotics for acute asthma in United States emergency departments," by Stefan G. Vanderweil, B.A., Chu-Lin Tsai, M.D., M.P.H., Andrea J. Pelletier, M.P.H., M.S., and others in the August 2008 Academy of Emergency Medicine 15(8), pp. 736-743.

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